Maple Leaf Pain Relief

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MAPLE LEAF PAIN RELIEF

Practice address

908 E Ireland Rd
South Bend, IN 46614-2664

Phone

(214) 284-1420

NPI assigned

Nov 7, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shannon Roberts

Title

Owner

Phone

(214) 284-1420

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1114469277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6628 GREENRIDGE DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462781184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 E IRELAND RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466142664",
            "telephone_number": "214-284-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE LEAF PAIN RELIEF",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-284-1420"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Manglos, RBT
• Walter Joy Manit, RPT
• Amy Sue Mannell, BA
• Linda A Mansfield, MD
• Gervasis Manuel, PHARM.D
• Mar-Main Pharmacy
• Sarah Elizabeth Marchesseault
• John Philip Marchin, M.D.
• David G Mark, MD
• James M Mark, M.D.

• Family Nurse Practitioner in South Bend, IN
• Providers in South Bend, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.